Pancreatic cancer usually has no symptoms in its early stages, so many people are diagnosed when the cancer is advanced. If the cancer is in nearby organs or blood vessels (locally advanced), or has spread (metastasised) to other parts of the body, surgery to remove the cancer may not be possible. Instead treatments will focus on relieving symptoms such as jaundice, digestive problems and pain. This is called palliative treatment.
It is often assumed that palliative treatment is only for people at the end of life; however, it can help at any stage of a pancreatic cancer diagnosis. It does not mean giving up hope – rather, it is about managing symptoms as they occur and living for as long as possible in the most satisfying way you can.
This section describes treatments for managing common symptoms of advanced pancreatic cancer, such as:
- jaundice – caused by narrowing of the common bile duct
- persistent vomiting and weight loss – caused by a blockage in the stomach or small bowel
- poor digestion – caused by blockage of the pancreatic duct, which stops the flow of the digestive enzymes required to break down food
- pain – in the abdomen and middle back.
These treatments may include surgery, chemotherapy and radiation therapy, either on their own or in combination.
See information on managing dietary issues that may be caused by pancreatic cancer and its treatment.
Surgery to relieve symptoms
If the tumour is pressing on the common bile duct, it can cause a blockage and prevent bile from passing into the bowel. Bile builds up in the blood, causing symptoms of jaundice, such as yellowing of the skin and whites of the eyes; itchy skin; reduced appetite, poor digestion and weight loss; and dark urine and pale stools.
If cancer blocks the duodenum (first part of the small bowel), food cannot pass into the bowel and builds up in your stomach, causing nausea and vomiting.
Blockages of the common bile duct or duodenum are known as obstructions. Options for managing obstructions may include:
- stenting – inserting a small tube into the bile duct or duodenum (this is the most common method, see below)
- double bypass surgery – connecting the small bowel to the bile duct or gall bladder to redirect the bile around the blockage, and connecting a part of the bowel to the stomach to bypass the duodenum so the stomach can empty properly
- gastroenterostomy – connecting the stomach to the jejunum (middle section of the small bowel)
- venting gastrostomy – connecting the stomach to an artificial opening on the abdomen so waste can be collected in a bag outside the body.
Sometimes a surgeon may have planned to remove a pancreatic tumour during an operation, but discovers the cancer has spread. If the tumour cannot be removed, the surgeon may perform one of the operations listed above to relieve symptoms.
Inserting a stent
If the cancer cannot be removed and is pressing on the common bile duct or duodenum, a stent may be inserted. A stent is a small tube made of either plastic or metal. It holds the bile duct or duodenum open, allowing the bile or food to flow into the bowel again.
The stent is usually inserted during a procedure known as an ERCP (endoscopic retrograde cholangiopancreatography). In an ERCP, an endoscope is passed into the bile duct via your mouth, stomach and duodenum. With the help of x-rays, the stent is positioned across the blockage to keep the bile duct or duodenum open. You may have the ERCP as an outpatient or stay in hospital for 1–2 days.
Jaundice symptoms usually go away over 2–3 weeks. Your appetite is likely to improve and you may gain some weight.
Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. It is sometimes used in combination with radiation therapy (chemoradiation) to treat locally advanced cancers, i.e. cancer that has spread beyond the pancreas and cannot be removed with surgery.
If you have advanced pancreatic cancer, chemotherapy may be given as palliative treatment to relieve symptoms.
If you need chemotherapy, you will be referred to a medical oncologist. You will usually have the chemotherapy drugs by drip into a vein (intravenously). To avoid damaging the arm veins, it may be given through a small device called a port-a-cath. This is inserted under the skin near the collarbone and can stay in place until all your chemotherapy treatment is over.
Typically, you will have each course of treatment as an outpatient, and it will be followed by a break or rest period of 1–3 weeks. Your medical team will assess how the treatment is working based on your symptoms and wellbeing, as well as scans and blood tests.
Tell your doctors about any prescription, over-the-counter or natural medicines you are taking or planning to take, as these may affect how the chemotherapy works in your body. For information about natural medicines and other complementary therapies, see Understanding Complementary Therapies or call Cancer Council 13 11 20.
Side effects of chemotherapy
Chemotherapy affects all fast-growing cells in the body. As well as killing cancer cells, it can damage healthy fast-growing cells such as white blood cells (which fight infections), hair cells and the cells lining the mouth and digestive system. These healthy cells usually recover quickly, but until then, you may have side effects such as:
- fatigue and tiredness
- nausea and/or vomiting
- fewer red blood cells (anaemia), leaving you weak and breathless
- fewer white blood cells, causing poor resistance to infection
- mouth ulcers and skin rashes
- hair loss (only with some chemotherapy drugs)
- diarrhoea and/or constipation
- flu-like symptoms such as fever, headache and muscle soreness
- poor appetite.
You may have none or only some of these side effects. Most side effects are temporary and can be managed, so discuss how you are feeling with your medical oncologist and chemotherapy nurses. For more information, talk to your treatment team, call Cancer Council 13 11 20 or see Understanding Chemotherapy.
Immunotherapy is a type of cancer drug treatment that uses the body's own immune system to fight cancer. So far, immunotherapy has had disappointing results for pancreatic cancer, but research is continuing and there are new clinical trials underway.
Also known as radiotherapy, radiation therapy uses radiation to kill cancer cells or injure them so they cannot multiply. The radiation is usually in the form of x-rays and it can be targeted at the cancer. Treatment is painless and planned to do as little harm as possible to healthy body tissue.
If you need radiation therapy, you will see a radiation oncologist. The treatment is usually given Monday to Friday, for up to five or six weeks, and each session takes 10–15 minutes. With locally advanced pancreatic cancer, radiation therapy is usually given with chemotherapy (chemoradiation). Chemoradiation may also be used before or after surgery for early pancreatic cancer.
Radiation therapy may be used on its own over shorter periods to relieve symptoms such as pain caused by tumours pressing on a nerve or another organ.
Side effects of radiation therapy
Radiation therapy can cause temporary side effects, which are mainly related to the area treated. For pancreatic cancer, the treatment is targeted at the abdomen. Side effects may include tiredness, nausea and vomiting, diarrhoea, poor appetite and skin irritation. Talk to your doctor or radiation oncology nurse about managing these side effects.
For more information see Understanding Radiation Therapy or call Cancer Council 13 11 20.
Managing pain in pancreatic cancer
A range of treatments can help to relieve pain in pancreatic cancer. These include:
- strong medicines such as opioids
- nerve blocks – injecting anaesthetic into nerves
- chemotherapy and/or radiation therapy to shrink cancer pressing on nerves.
Tell your treatment team about any pain, as it is easier to control if treated early. They can also refer you to a pain specialist if needed. See Overcoming Cancer Pain or call Cancer Council 13 11 20.
How palliative care can help
The options described in this section are generally considered palliative treatment because their main aim is to improve quality of life by reducing symptoms. Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, practical, emotional, spiritual and social needs. The team also provides support to families and carers.
Specialist palliative care services see people with complex needs and can also advise other health care professionals. Contacting a specialist palliative care service soon after diagnosis gives them the opportunity to get to know you, your family and your circumstances. You can ask your treating doctor for a referral. For free copies of Understanding Palliative Care and Living with Advanced Cancer, call Cancer Council 13 11 20 or visit your local Cancer Council website.
- When pancreatic cancer is advanced or cannot be surgically removed, the aim of treatment is to control the cancer for as long as possible and to relieve symptoms. This is known as palliative treatment.
- Symptoms of advanced pancreatic cancer may include jaundice; vomiting and weight loss; poor digestion; and pain.
- The tumour may cause a blockage in the common bile duct or duodenum (first part of the small bowel).
- The usual treatment for a blockage is to insert a small tube called a stent. This allows bile to flow into the bile duct, or food to move into the bowel.
- The most common procedure to insert a stent is known as an ERCP (endoscopic retrograde cholangiopancreatography).
- In some cases, the surgeon will need to relieve a blockage by connecting different parts of the digestive system together. Operations that do this include double bypass surgery, gastroenterostomy and venting gastrostomy.
- Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. For advanced pancreatic cancer, it may be used on its own or combined with radiation therapy (chemoradiation).
- Radiation therapy, which directs radiation such as x-rays at the cancer, is sometimes used with chemotherapy (chemoradiation) or on its own as a palliative treatment.
- Palliative care helps to improve your quality of life by addressing your physical, practical, emotional, spiritual and social needs. It also supports families and carers.
Expert content reviewers:
Dr Lorraine Chantrill, Senior Staff Specialist Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, and Honorary Research Fellow, Garvan Institute of Medical Research, NSW; Jennifer Arena, Pancreatic and Neuroendocrine Cancer Care Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, and Northern Cancer Institute, NSW; Dr Michael Briffa, Southern Adelaide Palliative Services, Flinders Medical Centre, SA; Rachel Corbett, 13 11 20 Consultant, Cancer Council Victoria; A/Prof Nick O'Rourke, The University of Queensland, Chairman of General Surgery, Head of Hepatobiliary Surgery, Royal Brisbane and Women's Hospital, QLD; Steve Pendry, consumer; Caley Schnaid, Accredited Practising Dietitian, Northern Cancer Institute and Wellac Lifestyle, NSW; Deane Standley, Consumer.